Provider Demographics
NPI:1851503403
Name:VEGA TARR, LUCILLE A (LBSW LPC)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:A
Last Name:VEGA TARR
Suffix:
Gender:F
Credentials:LBSW LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 BLACKHAWK RIVER DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6416
Mailing Address - Country:US
Mailing Address - Phone:505-771-2273
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1173
Practice Address - Country:US
Practice Address - Phone:505-836-1303
Practice Address - Fax:505-836-3810
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085021101YM0800X
NMB3592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker